La disponibilidad de la cardiología intervencionista y su relación con el pronóstico de los pacientes con infarto agudo de miocardio tratados con fibrinólisis

[Results of the performance of percutaneous coronary revascularization procedures without the presence of heart surgery]

The offer of percutaneous coronary revascularization procedures has extended over a large number of health care sites including those that do not have heart surgery. This phenomenon is related with the favorable results of the coronary angioplasty in the treatment of acute coronary syndrome, reported in the scientific literature, above all after the appearance of the coronary stent and the new antiaggregant drugs. In order to offer the primary angioplasty to the population as a treatment that is more effective than drug revascularization, sites having coronary interventionism without heart surgery and sometimes with low volume of patients per year have proliferated. At present, a review is being made of the convenience of continuing with this tendency and reflection is made on the necessary conditions in the expansion of these percutaneous procedures through the secondary level health care sites. The initial data of this review seem to indicate that the existence of interventionist cardiology laboratories in sites without heart surgery can be defended when a minimum number of procedures per year is guaranteed, the primary angioplasty and rescue one being those that have the best results. However, worse results are obtained in sites not supported by heart surgery when non-primary, non-rescue angioplasties and non-ST elevation acute coronary syndromes are dealt with and above all when there is a small volume of patients per year.